A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
- Inspection (viewing).
- Skin, mucous membranes, and sclerae (white part of the eye) [night sweats; pale skin color; pruritus (itching); chronic urticaria (hives)]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Inspection of the neck [swelling of the parotid (parotid gland)].
- Inspection and palpation (palpation) of the lymph node stations (cervical, axillary, supraclavicular, inguinal) [lymph node swelling (these feel coarse and painless; as the disease progresses, lymph node swelling always occurs)]
- Auscultation (listening) of the heart.
- Auscultation of the lungs [dyspnea (shortness of breath)]
- Examination of the abdomen (belly) [hepatosplenomegaly (liver and spleen enlargement)?; due topossible sequelae: hypersplenism – complication of splenomegaly (splenomegaly); leads to increase in functional capacity beyond the necessary level; as a result, there is excessive elimination of erythrocytes (red blood cells), leukocytes (white blood cells) and platelets (blood platelets) from the peripheral blood, causing pancytopenia].
- Percussion (tapping) of the abdomen.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
- Percussion (tapping) of the abdomen.
- Inspection of the genitals [due todifferential diagnosis: other forms of leukemia, e.g., acute lymphoblastic leukemia (ALL), which is associated with painless, usually unilateral testicular swelling]
- Inspection (viewing).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
